Association between History of Prolonged Exclusive Breast-Feeding and the Lung Function Indices in Childhood.

Although the propitious effects of breastfeeding on children's health are indisputable, the impact of exclusive breastfeeding on the lung function later in life remains controversial. Our objective was to explore the possible associations between breastfeeding and the lung function of children who were exclusively breastfed for an extensive period of time. This was a cross-sectional study of children who were exclusively breastfed for more than 12 months. Demographics and anthropometric data were collected; the body mass index (BMI), % body fat, and % central obesity were calculated; and all the participants underwent standard spirometry with reversibility testing. The relationship between breastfeeding duration and spirometric parameters was assessed by Spearman's correlation and multivariable regression, after adjustment for other confounders. Forty-six children (21 boys), aged 9.2 ± 2.4 years, with a reported breastfeeding duration of 27.5 ± 12.5 months (range 12-60 months) were included; 13% were overweight (none were obese) and 21.7% had central obesity. The average FEV1 was 104.7 ± 10.4% and the average FEF25-75 was 107.9 ± 13.3%. The duration of exclusive breastfeeding was positively correlated with FEF25-75% (r = 0.422, p = 0.003). Multivariable linear regression analysis confirmed the above finding (beta coefficient 0.478, p = 0.002), independently of age, overweight, and central obesity. No correlation was noted between the duration of breastfeeding and other spirometric parameters. In addition to its favorable impact on the metabolic profile, prolonged exclusive breastfeeding seems to exert a propitious effect on the function of smaller airways throughout childhood.

Association of breastfeeding with tidal breathing analysis in infants with bronchiolitis.

BACKGROUND: Tidal breathing flow-volume (TBFV) analysis provides important information about lung mechanics in infants. AIM: To assess the effects of breastfeeding on the TBFV measurements of infants who recover from acute bronchiolitis. METHODS: In this cross-sectional study, TBFV analysis was performed in infants with bronchiolitis prior to hospital discharge. The ratio of time to peak expiratory flow to total expiratory time (tPEF/tE) at baseline and after the administration of 400 mcg salbutamol was evaluated. RESULTS: A total of 56 infants (35 boys), aged 7.4 ± 2.8 mo, were included. Of them, 12.5% were exposed to tobacco smoke and 41.1% were breastfed less than 2 mo. There were no differences in baseline TBFV measurements between the breastfeeding groups; however, those who breastfed longer than 2 mo had a greater change in tPEF/tE after bronchodilation (12% ± 10.4% vs 0.9% ± 7.1%; P < 0.001). Moreover, there was a clear dose-response relationship between tPEF/tE reversibility and duration of breastfeeding (P < 0.001). In multivariate regression analysis, infants who breastfed less (regression coefficient -0.335, P = 0.010) or were exposed to cigarette smoke (regression coefficient 0.353, P = 0.007) showed a greater change in tPEF/tE after bronchodilation, independent of sex, prematurity, and family history of asthma or atopy. CONCLUSION: Infants who recover from bronchiolitis and have a shorter duration of breastfeeding or are exposed to cigarette smoke, have TBFV measurements indicative of obstructive lung disease.

Elevated Levels of Alveolar Nitric Oxide May Indicate Presence of Small Airway Inflammation in Patients with Inflammatory Bowel Disease.

INTRODUCTION: Pulmonary manifestations of inflammatory bowel disease (IBD), albeit not rare, are largely overlooked in clinical practice. The role of exhaled nitric oxide (eNO) as an established biological marker of airway inflammation compels us to use it as a tool to investigate the exact nature of these manifestations. METHODS: Fractional eNO (FeNO) was measured in multiple flows, and with the use of a mathematical model, alveolar concentration of NO (CANO) and bronchial flux of NO (JawNO) were assessed in 27 patients with IBD [17 with Crohn's disease (CD) and 10 with ulcerative colitis (UC)] and in 39 healthy controls. Carefully selected criteria were used to exclude patients or healthy controls that presented factors considered to be correlated with eNO measurements. Disease activity was measured in Crohn's patients using the CD activity index (CDAI) score and in UC using the partial Mayo score. RESULTS: CANO was significantly higher in the IBD group, compared to the control group (p < 0.0001). FeNO was significantly increased in patients with IBD (p = 0.023), while there was no statistical significance found regarding levels of JawNO in patients with IBD (p = 0.106), both compared to controls. There was no significant correlation between any eNO component and markers of disease activity. CONCLUSIONS: Alveolar concentration of NO is elevated in patients with IBD, regardless of disease activity. This may suggest that subclinical small airway inflammation is present in patients with IBD, even those with mild or inactive disease.

The Effect of pT-TMS on Beta Rhythm in Children with Autism Disorder. A MEG Study.

We investigated the beta rhythm in 10 children with autism disorders (six boys and four girls) aged 5-12 (mean± SD: 8.3± 2.1) before and after the application of pico Tesla transcranial magnetic stimulation (pT-TMS) using magnetoencephalography (MEG). The MEG was car-ried out in a magnetically shielded room with a whole-head 122-channel gradiometer. After applying pT-TMS, we observed a beta rhythm increase towards the frequency range of 18-26 Hz in seven out of 10 patients (70%). We created a score that rated the level of improvement for each patient: 1=some change; 2=minor change; and 3=major change. All patients had an improvement in their clinical symptoms after the application of pT-TMS. There was a correlation between the clinical score and the increase of channels in the frequency range 18-26 Hz after pT-TMS. We concluded that the application of pT-TMS affected the beta rhythm in children with autism disorder. Therefore, more studies need to be further conducted.

Association of Asthma and Allergic Rhinitis With Sleep-Disordered Breathing in Childhood.

Objective: Asthma and allergic rhinitis (AR) are the most common chronic conditions in childhood and have previously been linked to sleep-related breathing disorder (SRBD). Aim of the study was to examine the association between SRBD risk and asthma control in children with asthma and with or without AR. Methods: The assessment of FeNO and pulmonary function tests were performed in 140 children (65 with asthma, 57 with both asthma, and AR, 18 with only AR). Children with asthma completed the childhood Asthma Control Test (c-ACT), and the Sleep-Related Breathing Disorder scale, extracted from the Pediatric Sleep Questionnaire (PSQ). C-ACT scores ≤ 19 are indicative of poor asthma control whereas SRBD from PSQ scores ≥ 0.33 are suggestive of high risk for SRBD. Results: Mean age ± SD was 7.8 ± 3.1 years. Mean PSQ ± SD and c-ACT ± SD scores were 0.17 ± 0.14 and 24.9 ± 3.2, respectively. High risk for SRBD was identified in 26 children. Children at high risk for SRBD had significantly decreased c-ACT score (P = 0.048), verified by a negative association between c-ACT and PSQ-SRBD scores (r = -0.356, P < 0.001). Additionally a difference in diagnosis distribution between children at high or low risk for SRBD was observed. More specifically, among children at high risk, 88.5% were diagnosed with both atopic conditions, while this percentage among children at low risk was 29.8%. Asthma was mainly diagnosed in the latter group (P < 0.001). Conclusions: Poor asthma control is associated with SRBD. The presence of AR in children with asthma seems to increase the prevalence of SRBD in that particular population, requiring further investigation toward this direction.

The effect of bronchodilation and spirometry on fractional exhaled nitric oxide (FeNO50), bronchial NO flux (JawNO) and alveolar NO concentration (CANO) in children and young adults.

OBJECTIVE: Fractional exhaled nitric oxide (FeNO), bronchial nitric oxide (JawNO) and alveoar nitric oxide (CANO) are biomarkers of eosinophilic inflammation, usually measured simultaneously with spirometry and bronchodilation. Our aim was to investigate the effect of bronchodilation and spirometry on FeNO, CANO and JawNO in children and young adults with well-controlled asthma and in healthy volunteers. METHODS: FeNO was measured in 95 subjects (62 controls, 33 asthmatics). CANO and JawNO were assessed in 41 of the subjects (35 healthy, 6 asthmatics.) Measurements were performed before spirometry (1), right after spirometry (2), 20 min after the first spirometry and bronchodilation (3), right after the post-bronchodilation spirometry (4) and 30 min after the last spirometry (5). RESULTS: The presence of well-controlled asthma was not associated with different pattern of reaction after spirometry and bronchodilation. A statistically significant difference was observed only between FeNO4 and FeNO5, as well as between CANO1 and CANO3 (19.14 ± 1.68 vs 20.62 ± 1.85 ppb, p = 0.001 and 4.42 ± 0.40 vs 3.09±0.32 ppb, p = 0.001, respectively). CONCLUSIONS: Spirometry and bronchodilation have an insignificant effect on FeNO and JawNO. Even if a slight change occurs in FeNO and JawNO, this does not modify clinician's decision and therapeutic strategy. CANO values (CANO1) are significantly decreased 20 min after spirometry and bronchodilation.

A short period of breastfeeding in infancy, excessive house cleaning, absence of older sibling, and passive smoking are related to more severe atopic dermatitis in children.

BACKGROUND: Atopic dermatitis (AD) is one of the most common, chronic or chronically relapsing inflammatory skin diseases that affect children. Multiple genetic and environmental factors appear to regulate the pathogenesis of AD. OBJECTIVES: Our aim was to investigate the possible association between family, social, dieting, atopic and environmental factors and the severity of AD evaluated by SCORAD scores in children. MATERIALS & METHODS: The study group included 100 children with AD who attended a paediatric dermatology outpatient clinic with a median age of 18.5 months. The diagnosis of AD was established on the basis of the clinical criteria according to the American Dermatology Society, while the SCORAD score was used to evaluate disease severity. RESULTS: Multivariate linear regression analysis disclosed that excessive cleanliness (p<0.001), RAST level greater than 0.7 KU/l (p<0.001), breastfeeding for less than two months (p = 0.001), and the absence of an older sibling (p = 0.049) were statistically significant independent determinants for high SCORAD scores. Multivariate logistic regression analysis showed that excessive cleanliness (p<0.001) was the strongest independent risk factor for severe AD (SCORAD>36) (aOR: 59.4; 95% CI: 10.9-322.6). RAST level greater than 0.7 KU/l (aOR: 7.9; 95% CI: 1.5-41.0; p = 0.014) and severe passive smoking (aOR: 4.6; 95% CI: 1.0-22.1; p = 0.050) also showed a significant independent, but clearly weaker, association with severe AD. CONCLUSIONS: A short duration of breastfeeding, absence of older siblings, parental passive smoking, food allergens along with aeroallergens, and excessive cleanliness should be considered as negative prognostic factors, leading to a higher SCORAD score in children with AD.

Endothelial nitric oxide synthase gene polymorphisms are associated with sensitization to seasonal aeroallergens in asthmatic children.

BACKGROUND: Childhood asthma phenotype is the consequence of interaction between environment and genetic factors. Nitric oxide (NO) formation is affected by polymorphisms in nitric oxide synthase (NOS) enzymes, which play a significant role as inflammatory factors in the airways. This study was undertaken to estimate the correlation of -786C>T and 894G>T polymorphisms of the eNOS gene with the sensitization of asthmatic children to common aeroallergens. METHODS: A total of 193 asthmatic children and 96 healthy controls, who were of Mediterranean origin, living in the same geographical area, were enrolled in the study. 894G>T and -786T/C polymorphisms of the eNOS gene were analyzed using a PCR-RFLP method. RESULTS: The 894GG genotype was more frequent (68.6%) in children with asthma sensitized to Oleaeuropaea than in those with asthma non-sensitized (43.0%) (P=0.004). Likewise, -786TT genotype frequency was higher in children with asthma sensitized to Oleaeuropaea (51.0%) than in those with asthma nonsensitized (31.7%) to this allergen (P=0.035). For the aeroallergens Parietariajudaica and mixed grass, the frequency of -786C allele carriage was associated with protection from sensitization to Parietariajudaica and mixed grass in asthmatic children (P=0.021 and P=0.017, respectively). In the healthy control group, the genotype frequencies for these polymorphisms were similar to genotype frequencies of children with asthma non-sensitized to these three specific aeroallergens. CONCLUSION: In children with asthma, 894G>T and -786T/C polymorphisms of the eNOS gene were correlated with sensitization to common seasonal aeroallergens.

A combined study of MEG and pico-Tesla TMS on children with autism disorder.

Magnetoencephalographic (MEG) recordings from the brain of 10 children with autism (6 boys and 4 girls, with ages range from 5-12 years, mean[Formula: see text][Formula: see text][Formula: see text]SD: 8.3[Formula: see text][Formula: see text][Formula: see text]2.1) were obtained using a whole-head 122-channel MEG system in a magnetically shielded room of low magnetic noise. A double-blind experimental design was used in order to look for possible effect of external pico-Tesla Transcranial Magnetic Stimulation (pT-TMS). The pT-TMS was applied on the brain of the autistic children with proper field characteristics (magnetic field amplitude: 1-7.5[Formula: see text]pT, frequency: the alpha - rhythm of the patient 8-13[Formula: see text]Hz). After unblinding it was found a significant effect of an increase of frequencies in the range of 2-7[Formula: see text]Hz across the subjects followed by an improvement and normalization of their MEG recordings. The statistical analysis of our results showed a statistical significance at 6 out of 10 patients (60%). It is also observed an increase of alpha activity in autistic children at the end of one month after pT-TMS treatment at home. In conclusion, the application of pT-TMS has the prospective to be a noninvasive, safe and important modality in the management of autism children.

The Role of Flow-Independent Exhaled Nitric Oxide Parameters in the Assessment of Airway Diseases.

Nitric oxide (NO), the first gas known to act as a biological messenger, is one of the most widely studied free radical/gas in medicine, both for its biological function and therapeutic applications. The measurement of endogenous NO in exhaled air is widely used in the evaluation of lung disorders. Partitioning of exhaled nitric oxide (eNO) is of increasing interest because of the additional information about lung pathology and distal lung inflammation that can be obtained. Specifically, measuring exhaled NO at multiple flow rates allows assessment of the flow-independent NO parameters: alveolar NO concentration (CalvNO), bronchial NO flux (JNO), bronchial wall NO concentration (CWNO), and bronchial diffusing capacity of NO (DNO). Several studies have reported that there were different patterns of those parameters in different airway diseases and/or in different severities of the same disease, mostly in asthma. Specifically, while JNO seems to provide the same information as FeNO50, alveolar NO concentration appears to be an independent parameter that is putatively associated with increased distal lung inflammation and more severe disease. However, despite much research interest in partitioning exhaled NO, clinical usefulness has yet to be established.

Can Procalcitonin in Cerebrospinal Fluid be a Diagnostic Tool for Meningitis?

BACKGROUND: To study the levels of procalcitonin (PCT) in patients with meningitis and control group and compare them with established markers of infection--such as C-reactive protein (CRP), high-sensitivity CRP, and WBC--in cerebrospinal fluid (CSF) and assess the possible discriminative role of PCT in the differential diagnosis of meningitis from other noninfectious diseases. METHODS: We studied CSF samples of patients from Intensive Care Unit, Internal Medicine, Neurology, Hematology, and Pediatric departments. The total number of patients included in the study was 58. The samples were divided into three groups: group 1 with bacterial meningitis (BM) central nervous system (n = 19); group 2 with viral meningitis (VM, n = 11); and group 3, control group, with noninfectious diseases (n = 28). RESULTS: Values of PCT levels >0.5 ng/ml were considered as abnormal. In group 1, mean PCT levels were 4.714 ± 1.59 ng/ml. In group 2, all patients had PCT <0.5 ng/ml (0.1327 ± 0.03 ng/ml). In group 3, the mean PCT levels were <0.1 ng/ml. CONCLUSION: PCT values in CSF can be very helpful in distinguishing BM from VM and other noninfectious diseases.

Vitamin D receptor ApaI a allele is associated with better childhood asthma control and improvement in ability for daily activities.

Vitamin D levels have been suggested as a marker of disease severity in asthmatic children. Our aim was to investigate possible associations between the vitamin D receptor (VDR) FokI, BsmI, ApaI, and TaqI polymorphisms and asthma susceptibility and control in children. 127 Greek children with asthma and 91 healthy controls were genotyped for VDR FokI, BsmI ApaI, and TaqI polymorphisms using Sequenom MassARRAY iPLEX platform. Asthma control was assessed according to the Global Initiative for Asthma guidelines (GINA) and Childhood Asthma Control Test (C-ACT) and, for the first time, tested for its possible association with VDR SNPs. Asthmatic children were grouped as "controlled (n=49)", "partially controlled (n=38)," and "uncontrolled (n=40)," according to GINA classification. No association was found between VDR polymorphisms and asthma prevalence. Asthmatic children with the VDR ApaI aa genotype had significantly higher C-ACT score compared with asthmatic children carrying the AA/AC VDR ApaI genotypes (p=0.011). The frequency of VDR ApaI aa genotype was significantly higher in controlled asthma group (n=92) than uncontrolled asthma group (n=35), according to C-ACT (24.5% vs 0.0%, p<0.001) and GINA (32.7% vs 7.5%, p=0.001). Also, VDR ApaI aa genotype was negatively associated with limitation in daily activities because of asthma (p=0.004). VDR ApaI aa genotype was positively associated with well-controlled asthma according to GINA and C-ACT questionnaire and negatively associated with decreased limitation in daily activities in asthmatic children, further supporting the importance of Vitamin D pathway in asthma.

Plasma leptin and adiponectin concentrations correlate with cardiometabolic risk and systemic inflammation in healthy, non-obese children.

BACKGROUND: Plasma adipocytokines are associated with metabolic profile and cardiovascular risk in obese children. OBJECTIVE: To investigate the association of plasma leptin and adiponectin concentrations with cardiometabolic risk profile and systemic inflammation in non-obese children. SUBJECTS: We studied 170 healthy, non-obese children (86 males, mean age 10±2 years). METHODS: Children's current body mass index (BMI), plasma leptin and adiponectin concentrations, lipid profile, fasting plasma glucose and high sensitivity C reactive protein (hsCRP) were measured. RESULTS: After adjustment for age, gender and BMI, plasma leptin concentrations were positively associated with hsCRP (t=2.72, p=0.009) and fasting plasma glucose (t=4.27, p<0.0001); plasma adiponectin concentrations were negatively associated with hsCRP (t=-3.31, p=0.0016); and positively with high density lipoprotein cholesterol (t=2.32, p=0.02). Children in the highest quartile of leptin/adiponectin (L/A) ratio demonstrated significantly higher BMI, systolic blood pressure, hsCRP, triglycerides and fasting glucose and the lowest high density lipoprotein (HDL) compared to lower L/A ratio quartiles. CONCLUSIONS: Alterations in plasma leptin and adiponectin may help to reclassify non-obese children, detecting those with more unfavorable risk profiles independent of BMI status.

Lipopolysaccharide-binding protein: a potential marker of febrile urinary tract infection in childhood.

BACKGROUND: Urinary tract infections (UTIs) are encountered frequently in children, and their early diagnosis and treatment are important. This study evaluates the diagnostic value of serum concentrations of lipopolysaccharide-binding protein (LBP), an acute-phase protein, in children with febrile UTI and compares it to those of the total white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6). METHODS: The study population comprised 77 consecutive patients with a first-episode febrile UTI (33 boys) with a median age of 11 months [interquartile range (IQR), 5.5-33 months], 21 healthy controls (11 boys) with a median age of 10 months (IQR, 5-20.5 months) and 58 febrile controls with a fever due to other causes (28 boys) with a median age of 12.5 months (IQR, 7-30 months). LBP, IL-6, PCT, and CRP were measured for both patients and control groups. RESULTS: The serum levels of LBP (p < 0.001), CRP (p < 0.001), PCT (p = 0.001), IL-6 (p = 0.002), ESR (p = 0.020), and WBC (p < 0.001) were higher in patients with febrile UTI than in the healthy and febrile control groups. The LPB cut-off value for best sensitivity and specificity in patients with febrile UTI was >43.23 mg/l. Furthermore, the area under the receiver operating characteristic curve was significantly greater for LBP than for CRP (p = 0.014), PCT (p < 0.001), ESR (p < 0.001), WBC (p = 0.002) and IL-6 (p = 0.006). CONCLUSIONS: The results of this study suggest that the serum LBP concentration constitutes a reliable biologic marker for the diagnosis of a febrile UTI in children.

G894T polymorphism of eNOS gene is a predictor of response to combination of inhaled corticosteroids with long-lasting ß2-agonists in asthmatic children.

AIM: Nitric oxide synthase enzymes have an important role in airway inflammation in asthmatic children. In the present study, the association between eNOS gene polymorphisms and response to inhaled corticosteroids (ICS) and long-lasting ß(2)-agonists (LABAs) was investigated. PATIENTS & METHODS: A total of 81 asthmatic children treated with ICS plus LABAs and 96 healthy controls were genotyped for eNOS G894T and -786T/C polymorphisms and their haplotypes using the PCR-RFLP method. RESULTS: G894T and -786T/C polymorphisms were not associated with asthma susceptibility. Among asthmatic children, 894TT carriers had higher change in forced expiratory volume in 1 s (FEV(1)) in response to ICS plus LABAs compared with 894GG carriers (21.9 ± 3.8 vs 1.6 ± 1.9%; p < 0.001). In responders (FEV(1) change ≥7.5%), frequency of 894TT genotype was significantly higher than in nonresponders (26.2 vs 2.6%, p < 0.001). Results for the -786T/C polymorphism alone were less clear and in most cases nonsignificant. CONCLUSION: The G894T polymorphism was associated with response to ICS and may serve as a useful pharmacogenetic marker of response to ICS plus LABAs in asthmatic children.

Current evidence for the management of paediatric parapneumonic effusions.

BACKGROUND: Parapneumonic effusions (PPE) and empyema, secondary to bacterial pneumonia, are relatively uncommon but their prevalence is increasing lately. Even if their prognosis is generally good, they may still cause significant morbidity. The traditional treatment of PPE has been intravenous antibiotics and, when necessary, chest tube drainage. Open thoracotomy with decortication has usually been applied in case of failure of the traditional approach. Lately, the use of fibrinolysis and/or video-assisted thoracoscopic surgery (VATS) are utilized in the management of PPE; however, there is still little consensus on the most effective primary treatment. SCOPE: In this article our goal was to summarize, based on up-to-date evidence, all the management options for PPE available to physicians and weigh the benefits and risks of the most popular ones, in an effort to figure out which one is superior as a first-line approach in children. FINDINGS: A literature search of randomized and retrospective studies that pinpoint methods of evaluation and treatment of PPE was carried out in Medline and Scopus databases. Chest X-ray, ultrasound as well as microbiology and biochemical characteristics of the pleural fluid will facilitate decision-making. Small uncomplicated effusions resolve with antibiotics alone, larger ones require small-bore chest tube drainage and in case of complicated loculated PPE, fibrinolysis or VATS should be considered. Both methods promote faster drainage, reduce hospital stay and obviate the need for further interventions when used as first-line approach. However, primary treatment with VATS is not advised by the majority of studies as a first choice intervention, unless medical treatment has failed. CONCLUSION: The main steps in treatment are diagnostic thoracocentesis and imaging, small percutaneous drainage, and considering fibrinolysis in complicated PPE. In case of failure, VATS should be the surgical method to be applied.

Plasma leptin and adiponectin concentrations in healthy, non-obese children.

BACKGROUND: Alterations in plasma leptin and adiponectin concentrations are associated with an adverse metabolic profile in obese children. OBJECTIVE: To simultaneously assess multiple factors with possible effects on plasma leptin and adiponectin concentrations in healthy, non-obese children. SUBJECTS: We studied 170 healthy non-obese children (86 males, age 10+1.5 years), with available medical records from birth. METHODS: Plasma leptin and adiponectin concentrations were assessed by immunoassay. The ratio of current weight/birth weight (WBWR) was used as an index of children growth from birth. Children's intensity of physical activity and parental characteristics were also assessed. RESULTS: Leptin was positively associated with WBWR (p<0.0001); parental smoking (analysis of variance, ANOVA; p-=0.03) and parental obesity (ANOVA; p<0.001) were negatively associated with breastfeeding (p<0.01) and children's access to exercise (p<0.0001). Adiponectin was negatively associated with WBWR (p<0.0001) and parental smoking (p=0.04), with an additive negative effect of parental smoking status and parental obesity on children's adiponectin levels (ANOVA; p=0.02). CONCLUSIONS: Children's and parental factors are related and could possibly influence leptin and adiponectin concentrations in healthy non-obese children. Early preventive strategies that target both children and parents could improve the profile of adipocytokine in these children.

Magnetoencephalography evaluation of febrile seizures in young children.

The aim of this study is to assess any cerebral dysfunction in young children, who experienced febrile seizures, by means of magnetoencephalography. Our study population included 15 children (9 boys, 6 girls) within the age range of 2 to 7 years. The magnetoencephalography data were recorded with a 122-channel biomagnetometer. Equivalent current dipoles were calculated for epileptic spikes on magnetoencephalography recordings according to the single dipole model. Of 15 children, 8 showed equivalent current dipoles that located at the left-temporal, right-temporal, occipital, and frontal lobe, as active regions responsible for febrile seizures. We assumed that the interictal epileptiform discharges are a consequence of febrile seizures. Of course, further study in a larger number of patients is needed to evaluate the exact role of the equivalent current dipoles, in young children, who experienced febrile seizures.

Serum procalcitonin for prediction of renal parenchymal involvement in children with urinary tract infections: a meta-analysis of prospective clinical studies.

OBJECTIVE: To determine by meta-analysis whether serum procalcitonin (PCT) is a useful marker of acute renal parenchymal involvement (RPI) in children with culture-proven urinary tract infection (UTI), as diagnosed by acute-phase DMSA (Tc-99m dimercaptosuccinic acid) renal scintigraphy. STUDY DESIGN: We searched PubMed and the Cochrane Central Register of Controlled Trials for prospective studies involving children with culture-proven UTIs. Additional eligibility criteria were measurement of serum PCT at presentation and performance of DMSA scintigraphy within 14 days. RESULTS: Overall, 10 studies eligible for inclusion, involving a total of 627 children, were identified. Half of these studies evaluated children with a first episode of UTI; 8 involved children with febrile UTIs. Using a cutoff value of 0.5 to 0.6 ng/mL, the pooled diagnostic odds ratio of serum PCT for UTI with RPI was 14.25 (95% confidence interval, 4.70 to 43.23). High statistical between-study heterogeneity that could mainly be attributed to 2 studies was observed. The remaining 8 studies uniformly favored PCT use. CONCLUSIONS: In children with culture-proven UTI, a serum PCT value >0.5 ng/mL predicts reasonably well the presence of RPI, as evidenced by DMSA scintigraphy. PCT may aid in the identification of children with UTI, necessitating more intense evaluation and management.